title: Postoperative radiotherapy in stage I/II endometrial cancer: retrospective analysis of 883 patients treated at the University of Florence.
abstract: The efficacy of postoperative radiotherapy (RT) in the treatment of early-stage endometrial carcinoma (EC) is still under debate. This study was aimed to review the outcome and adverse effects in patients treated for EC with postoperative RT at a single center.
  
  
  
  A total of 883 patients with pathological stages I to II EC were retrospectively analyzed. Surgery consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy, or vaginal hysteroannessiectomy in 532 patients (60.2%) with pelvic lymphadenectomy in 351 patients (39.8%). Seven hundred forty-seven patients (84.6%) underwent whole pelvic RT (WPRT) and 136 (15.4%) combined WPRT and vaginal brachytherapy (BT) boost.
  
  
  
  At a median follow-up of 9 years (range, 1.2-27.6 years), we observed 10.6% disease relapse. Forty-seven patients experienced local recurrence (LR), and 38 patients experienced distant metastases (DMs). At univariate analysis, age at diagnosis (P < 0.0001), stage (P < 0.04), and histological subtype (P < 0.0001) resulted in significant prognostic factors. At multivariate analysis, histotype emerged as an independent relapse predictor (P = 0.0001). Acute WPRT-related toxicity was mild; diarrhea was the most common adverse effect (19.8%). We recorded long-term adverse effects in 7.8% of the patients.
  
  
  
  Our study showed that patients with early-stage EC have a good outcome in overall survival and disease-free survival. In our experience, standard surgery (including hysterectomy and bilateral salpingo-oophorectomy followed by WPRT with or without BT) showed an acceptable toxicity profile.
authors.affiliation: Department of Radiation Oncology, University of Florence, Florence, Italy. v.scotti@dfc.unifi.it
authors.forename: Vieri
authors.initials: V
authors.lastname: Scotti
authors.forename: Simona
authors.initials: S
authors.lastname: Borghesi
authors.forename: Icro
authors.initials: I
authors.lastname: Meattini
authors.forename: Calogero
authors.initials: C
authors.lastname: Saieva
authors.forename: Francesca
authors.initials: F
authors.lastname: Rossi
authors.forename: Alessia
authors.initials: A
authors.lastname: Petrucci
authors.forename: Alessandra
authors.initials: A
authors.lastname: Galardi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Livi
authors.forename: Benedetta
authors.initials: B
authors.lastname: Agresti
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fambrini
authors.forename: Mauro
authors.initials: M
authors.lastname: Marchionni
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Biti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000009:adverse effects; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods; D007558:Italy; D008875:Middle Aged; D009367:Neoplasm Staging; D010052:Ovariectomy / Q000009:adverse effects / Q000379:methods; D011184:Postoperative Period; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies